Abstract
Background
Diagnosing pneumonia and other lung conditions can be challenging in patients with
severe intellectual or physical disabilities or severe chest deformities. Physical
examination is sometimes difficult to perform and the frequently requested chest x-ray
(CXR) study is often of little value in the diagnostic approach to this population.
Point-of-care lung ultrasound (US) is an emerging diagnostic tool with particularly
high level of accuracy in detecting pneumonia, pleural effusion, and pneumothorax.
Case Report
This case series describes four cases demonstrating the usefulness of point-of-care
US in a pediatric emergency department for lung assessment in patients for differentiation
and diagnosis of acute causes of acute respiratory symptoms, in whom clinical features
or CXR failed to confirm or exclude pulmonary complications.
Why Should an Emergency Physician Be Aware of This?
In patients with chest deformities, pulmonary complications can be disproportionately
frequent. Lung US should be recognized as an important adjunctive tool in this subset
of patients to detect pneumonia, pleural effusions, and pneumothorax. When used proactively,
it can reduce unnecessary radiation exposure, provide more certainty in determining
the diagnosis, and, most importantly, inform correct and timely management.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Life expectancy in children with cerebral palsy.BMJ. 1994; 309: 431-435
- Survival at 19 years of age in a total population of children and young people with cerebral palsy.Dev Med Child Neurol. 2011; 53: 808-814
- Mortality from 1 to 16–18 years in bilateral cerebral palsy.Arch Dis Child. 2011; 96: 1077-1081
- Development and reliability of a system to classify gross motor function in children with cerebral palsy.Dev Med Child Neurol. 1997; 39: 214-223
- Early death and causes of death of people with intellectual disabilities: a systematic review.J Appl Res Intellect Disabil. 2018; 31: 325-342
- Mortality in people with learning disability: risks, causes, and death certification findings in London.Dev Med Child Neurol. 1998; 40: 50-56
- Respiratory morbidity in children with profound intellectual and multiple disability.Pediatr Pulmonol. 2015; 50: 1033-1038
- Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative.Pediatr Radiol. 2002; 32: 228-231
- Lung ultrasound for the diagnosis of community-acquired pneumonia in children.Pediatr Radiol. 2017; 47: 1412-1419
- Lung ultrasound findings undetectable by chest radiography in children with community-acquired pneumonia.Ultrasound Med Biol. 2018; 44: 1687-1693
- Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis.Pediatrics. 2015; 135: 714-722
- Occult traumatic pneumothorax: diagnostic accuracy of lung ultrasonography in the emergency department.Chest. 2008; 133: 204-211
- Point-of-care ultrasonography for evaluation of acute dyspnea in the ED.Chest. 2017; 151: 1295-1301
- The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America.Clin Infect Dis. 2011; 53: e25-e76
- British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011.Thorax. 2011; 66: ii1-ii23
- Prospective observational study of point-of-care ultrasound for diagnosing pneumonia.Arch Dis Child. 2019; 104: 12-18
- Lung ultrasonography: a viable alternative to chest radiography in children with suspected pneumonia?.J Pediatr. 2016; 176: 93-98
- Admission chest radiograph lacks sensitivity in the diagnosis of community-acquired pneumonia.Am J Med Sci. 2009; 337: 236-240
- Radiation bioeffects, risks, and radiation protection in medical imaging in children.in: Coley B.D. Caffey’s Pediatric Diagnostic Imaging. Elsevier Saunders, Philadelphia2013: 3-11
- Screening performance characteristic of ultrasonography and radiography in detection of pleural effusion; a meta-analysis.Emerg (Tehran). 2016; 4: 1-10
- A prospective comparison of supine chest radiography and bedside ultrasound for the diagnosis of traumatic pneumothorax.Acad Emerg Med. 2005; 12: 844-849
- Emergency department resource use in pediatric pneumonia: point-of-care lung ultrasonography versus chest radiography.J Ultrasound Med. 2019; 38: 407-414
- Ultrasound diagnosis of pneumonia in children.Radiol Med. 2008; 113: 190-198
- Patterns of admissions for children with special needs to the paediatric assessment unit.Arch Dis Child. 2004; 89: 165-169
- Capnography in patients with severe neurological impairment.Res Dev Disabil. 2014; 35: 1259-1263
Article info
Publication history
Published online: April 01, 2020
Accepted:
February 15,
2020
Received in revised form:
January 22,
2020
Received:
July 4,
2019
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
